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Home / News & IndustryManaged Care Insight and Analysis
Updated: March 23, 2010
Care For Vulnerable Population Fails To Improve

For the third year in a row, NCQA found that the performance of health plans serving Medicare and Medicaid patients failed to appreciably improve quality on key measures.

That was called "unacceptable" by Vernon K. Smith, a principal in Lansing, Mich.-based Health Management Associates, and one of the nation’s leading experts on Medicaid. "Three years of little or no improvement in care quality is truly surprising, and should be unacceptable."

More than 100 million Americans depend on Medicare and Medicaid for their care and that number is growing. Enrollment grew in 2008 and will grow even more as the economy remains in free fall and the Baby Boom generation becomes eligible.

Congress is considering making changes to Medicare’s payment system for these plans, including the introduction of financial incentives to improve quality.

In another disturbing trend, the study found that quality of care varies from region to region in America. For example, Health plans in the New England region treating diabetes and cardiovascular disease continued to outpace all others and the quality of care in the South Central region for diabetes and cardiovascular disease did the worst.

"These quality gaps translate into preventable heart attacks, strokes and other serious medical events, not to mention billions of dollars in avoidable medical costs," said Cristie Upshaw Travis, CEO of the Memphis Business Group on Health.

NCQA again measured the value of health plans by combining quality measures with an assessment of how many resources were used to achieve those results. There were wide variations in both spending and quality and NCQA found essentially no relationship between cost and quality.

"Healthcare doesn’t follow the pay-more get-more rule," said NCQA Executive Vice President Dr. Greg Pawlson. "You can’t simply spend your way to better health or to a health care system that delivers high value for the costs."

NCQA’s full State of Health Care Quality 2009 report is available on the Web at To see the Health Plan Report Card, visit

  This article was taken from:
Healthcare Reimbursement Monitor

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